tbuckley/cabot-search huggingface dataset:
Abstract 10088: Electronic Cigarette Use and Chest Pain Report in US Adults
Authors: Leili Behrooz, Wubin Xie, Aboli Goghari, Rose M Robertson, Aruni Bhatnagar, Andrew Stokes, Naomi M Hamburg
Journal: Circulation (2022)

Electronic cigarettes (e-cigarettes) are advertised as a healthier alternative for combustible cigarettes and have become the most commonly used smoking product. There is limited data regarding the association of e-cigarettes and risk of cardiovascular disease (CVD). We assessed the association of chest pain reports across tobacco product use groups. We used data from the Population Assessment of Tobacco and Health (PATH) study which is a nationally representative longitudinal study of tobacco use behavior and health effects. We categorized tobacco use patterns into 4 groups: cigarette use, dual use, e-cigarette use, and non-use. Participants were asked if they have ever had chest pain and if they have had chest pain in the past 30 days. Binominal regression models were used to examine the association between tobacco use categories and the 2 chest pain outcomes. We adjusted for covariates including age, sex, race, education, BMI, hypercholesterolemia, hypertension, current use of other combustible tobacco products, secondhand smoke exposure, marijuana use in the past 30 days, recreational drug use and history of respiratory diseases. The cohort included 9,284 participants after excluding those with established CVD and those with missing outcome or exposure data. The Mean age was 57 (SD±11) years and 54% of participants were female. Among the participants, 3,020 were exclusive cigarette users, 213 were dual users, 175 were exclusive e-cigarette users (94% were former smokers), and 5,876 were non-users. Compared to non-use, combustible cigarette use had 1.48 (95% CI, 1.27, 1.73) odds of ever having chest pain and 1.72 (95% CI, 1.4, 2.11) odds of having chest pain in the past 30 days. Dual use was associated with 1.52 (CI 95%, 1.05, 2.19) odds of chest pain ever and 1.82 (95% CI, 1.17, 2.83) odds of 30 days chest pain. Exclusive e-cigarette use had 0.78 (95% CI, 0.49, 1.26) odds of ever having chest pain and 0.75 (95% CI, 0.39, 1.42) odds of having chest pain in the past 30 days. Our findings suggest that compared to non-use, exclusive e-cigarette use has similar rates of chest pain; whereas dual use and combustible cigarette use have increased rates of chest pain outcomes.
Abstract 05: Hospital Variation In Epinephrine Administration Prior To Defibrillation For Cardiac Arrest Due To Shockable Rhythm
Authors: Colten Stewart, Paul S Chan, kevin kennedy, Morgan Swanson, Saket Girotra
Journal: Circulation (2022)

Background: Contrary to guidelines, we recently found that epinephrine administration before first defibrillation for in-hospital cardiac arrest (IHCA) due to a shockable rhythm is not uncommon. However, the extent to which the above practice varies across hospitals and its association with hospital-level survival is unknown. Methods: Using 2000-19 data from the Get With The Guidelines ® -Resuscitation (GWTG-R) registry, we identified 57,816 adult patients (521 sites) with an index IHCA due to an initial shockable rhythm who received at least 1 defibrillation prior to achieving return of spontaneous circulation. We constructed multivariable hierarchical regression models to examine site-level variation in epinephrine before first defibrillation and its association with hospital survival. Results: Overall, the median rate of epinephrine before defibrillation was 18.8% and varied markedly across hospitals (range: 0%-70.6%, median odds ratio [OR] 1.50; 95% C.I. 1.43 - 1.57). Compared to hospitals in the lowest quartile (Q1) for epinephrine before defibrillation, hospitals in the highest quartile (Q4) were more likely to be major teaching hospitals and have more hospital beds. After adjusting for baseline variables, the median risk-standardized survival was 42.5% (IQR: 39.2%-46.0%). Compared to Q1 hospitals (epinephrine first rate of 0-12.4%), there was a stepwise decline in risk-standardized survival at hospitals with higher rates of epinephrine before first defibrillation: Q2: RR 0.95 [0.90-0.99]; Q3: RR 0.91 [0.87-0.96]; Q4: RR 0.81 [0.77-0.86]; P value for trend &lt;0.001. Conclusions: For patients with shockable IHCA, there is marked hospital variation in epinephrine administration prior to first defibrillation, and this practice is associated with lower rates of survival to discharge. Hospital efforts to prioritize immediate defibrillation for patients with shockable IHCA are urgently needed.
Abstract 10732: Independent Evaluation of Effects of a Virtual Employer-Sponsored Type 2 Diabetes Management Program on Blood Glucose
Authors: Zhen Chen, Charles E Birse, Maren Fragala, Michael J Mcphaul, Lance Bare
Journal: Circulation (2022)

Objective: To evaluate the effect of an employer-sponsored T2D management virtual program (Onduo) on blood glucose changes, via an independent data source, within the first year of participation. Methods: This retrospective pre-post study included participants with T2D who engaged in Onduo Dec 2020-Sept 2021. Participants had to have completed an employer-sponsored wellness program (independent of Onduo) with year-end biometric screening in 2019, 2020 and 2021, which included HbA1c, fasting glucose (FG), lipids, and other biometric measurements (Table). Year-to-year changes pre-intervention (2019 vs 2020 wellness screening, before Onduo) and post-intervention (2020 vs 2021) were compared using paired t-tests (significant at P ≤.05). We also assessed year-to-year changes based on use of specific Onduo telehealth tools (mobile app, blood glucose meter [BGM], health coach consultations, continuous glucose monitor [CGM], and telemedicine visits). Results: All 578 participants included (Table) used a mobile app, 84% used personalized coaching, 69% BGM, 13% telehealth visits, and 10% CGM. Seventy (12.1%) participants had HbA1c ≥9% in 2019, 79 (13.7%) in 2020, and 57 (9.9%) in 2021 (2019 vs 2020: P =.3; 2020 vs 2021: P =.01; Χ 2 tests). Within the first year of intervention, year-to-year changes in HbA1c, FG, HDL, and LDL significantly improved compared to pre-intervention changes (Table). The largest glycemic improvements post-intervention were in participants with baseline HbA1c ≥9% ( P &lt;.001; ANOVA) or baseline FG ≥126 mg/dL ( P &lt;.001; 2-sample t-test). Participants who used a CGM or telemedicine visits (n=81) had greater post-intervention drops (2020 vs 2021) in HbA1c than did others (-0.7 vs -0.2%, P &lt;.01; 2-sample t-test). Conclusions: Participation in Onduo improved year-to-year trends in HbA1c, FG, HDL, and LDL. Improvements in glycemia were greater in participants with the highest baseline glycemic indices and those who used a CGM or telemedicine visits.
Abstract 10162: Acquired Hemophilia A and STEMI: A Management Dilemma
Authors: Jevin Yabut, Gian Lima, Ritika Vankina, Swarup Kumar, Joyce Meng
Journal: Circulation (2022)

Introduction: Thrombotic events are a rare complication of recombinant activated factor VII (rFVIIa) therapy in patients with hemophilia (PWH). We present the case of a patient who developed ST-segment elevation myocardial infarction while receiving rFVIIa replacement therapy for acquired hemophilia A. Case Presentation: A 71-year-old male with non-invasive right ureteral urothelial carcinoma, hypertension, type 2 diabetes mellitus, hyperlipidemia, and non-obstructive coronary artery disease presented for elective robotic-assisted right distal ureterectomy and ureteral reimplantation. He had persistent hematuria after the procedure. Subsequent evaluation for coagulopathy found acquired FVIII deficiency. He received FVIII replacement therapy but failed to respond due to high levels of FVIII inhibitor. His coagulopathy partially improved after treatment with rFVIIa. Unfortunately, the patient developed ST changes on telemetry. 12 lead ECG showed ST elevations in leads II, III, and aVF. Echocardiogram showed hypokinesis of the inferior wall and preserved ejection fraction. A diagnosis of inferior ST segment elevation MI was made; fortunately, the patient was minimally symptomatic. His peak troponin I was 48 ng/mL (normal range &lt; 0.04 ng/mL). After multidisciplinary discussion, rFVIIa was discontinued since it can promote thrombosis. Neither therapeutic anticoagulation nor coronary angiography were pursued due to concerns for bleeding. The patient completed his inferior infarct without complications. His ureteral bleeding also had stopped despite holding rVIIa. Discussion: Acquired hemophilia A (AHA) is a rare entity found in individuals with no history of bleeding disorders in which autoantibodies are directed against clotting factor VIII. rFVIIa is a bypass agent that is approved for acute management of bleeding and perioperative course in AHA. Thrombotic complications are rare, reported in only 0.17% of cases, but its management is challenging. Anticoagulation can be considered depending on bleeding risk. We highlight the importance of an individualized approach with careful risk-benefit assessment and multidisciplinary discussion when managing PWH with acute coronary syndrome.
Abstract 10128: Recombinant Human Placental Growth Factor-2 Treatment in Porcine Ischemic Cardiomyopathy
Authors: Ming Wu, Peter Pokreisz, Piet Claus, Hilde Gillijns, Ellen Caluwe, Tom Janssens, Geert Reyns, Nele Kindt, Desire Collen, Stefan Janssens
Journal: Circulation (2022)

Background: Placental growth factor (PlGF)-2 induces neovascularization and improves myocardial function in atherosclerotic rodent myocardial ischemia models without stimulating plaque angiogenesis. This promising therapeutic profile of PlGF-2 warrants a double blind, randomized, and placebo-controlled feasibility and efficacy study in a large animal model, representative of human disease. Methods: We induced myocardial infarction (MI) in domestic pigs using a 75 min balloon occlusion of the mid-LAD followed by reperfusion. After 4 w, we randomized pigs with marked LV dysfunction (LVEF&lt;40%) to continuous IV infusion of 5, 15, 45 μg/kg/day rhPlGF-2 or PBS (CON) for 2 w using osmotic pumps. We evaluated treatment effect 8 w after MI using comprehensive MRI analysis of LV function and structure and performed postmortem histological analyses of LV vascularization and fibrotic remodeling. Results: In the pilot study (3 pigs/dose), PIGF plasma concentrations showed stable and sustained dose-dependent increases for 28 days without organ-specific side effects or systemic toxicity. Myocardial Ischemia/reperfusion induced LV dysfunction at 4 w (infarct size, 16±4 % of LV mass, n=42; LVEF, 34±4 %, range 19%-40%). In the dose escalation study using 5 (n=10), 15 or 45 μg/kg/day PlGF (n=11 per group), global LV function, and regional myocardial blood flow at rest or during stress, and infarct size did not differ between CON (n=10) and PlGF (Figure 1). Capillary densities and extent of LV interstitial fibrosis in infarct core and border zone were comparable between CON and PlGF. Conclusions: In this blinded randomized controlled trial, rhPIGF-2 did not improve global cardiac function in a porcine model of chronic ischemic cardiomyopathy, and failed to recapitulate therapeutic neovascularization reported in rodents. Our data emphasize the critical need for robust double blind, placebo controlled trials in representative large animal models before clinical translation.
Abstract 10730: Pkm2 Ablation Dysregulates Cardiac Glucose Metabolism in Mice
Authors: Katie C Lee, Allison L Williams, Ralph V Shohet
Journal: Circulation (2022)

Introduction: The predominant isoform of pyruvate kinase (PKM1) directs pyruvate to the Krebs cycle for oxidative metabolism in the healthy heart. Our lab described a hypoxia-mediated switch to the alternatively spliced isoform PKM2. The lower PKM activity of dimerized PKM2 redirects glycolytic metabolites to the pentose phosphate pathway (PPP) and lactate production. Recently, we have found that mice with deletion of Pkm2 had profound depletion of cardiac basal glucose and higher ROS levels compared to controls. Hypothesis: We hypothesize that glucose metabolism is dysregulated in the absence of Pkm2, where the remaining isoform PKM1 promotes oxidative metabolism, leading to accumulation of ROS. Methods: Global Pkm2 KO mice were used for this study. Transcript abundance was determined by RNA-seq and RT-qPCR. Cardiomyocytes were isolated according to an established Langendorff-free method, and metabolites were traced using [U- 13 C] glucose with LC/MS (n=3). ROS concentration was measured using DCFDA in cardiomyocytes incubated at 1% O 2 (n=4). Inflammatory marker C-reactive protein (CRP) was measured in plasma of mice before and after myocardial infarction (n=12). Results: Although glucose uptake was similar, glucose was redirected to fatty acid synthesis, the polyol pathway, and the PPP, and away from oxidative metabolism in Pkm2 KO cardiomyocytes. Despite the increased flux into the PPP, NADPH production was low. Assessment of ROS levels in normoxia revealed that Pkm2 KO cardiomyocytes had higher levels of ROS, possibly stimulating the inflammatory response in Pkm2 KO mice. CRP levels were higher in Pkm2 KO plasma at baseline. ROS remained high in Pkm2 KO cardiomyocytes after hypoxic treatment and CRP remained high in Pkm2 KO plasma after MI. Conclusions: Increased expression of Pkm1 in the Pkm2 KO mice increases flux of metabolites through oxidative metabolism, exacerbating mitochondrial ROS and activating the PPP. Although NADPH levels should have correlated with increased PPP flux, the low NADPH production in Pkm2 KO cardiomyocytes suggest rapid consumption of NADPH by ROS and fatty acid synthesis. This study suggests a role for hypoxia-stimulated PKM2 accumulation in stabilizing glucose flux to mitigate oxidative stress in the ischemic heart.
Abstract 10137: Area Deprivation Index Predicts Annual Chronic Kidney Disease Screening and Chronic Kidney Disease Development Among Newly Diagnosed Hypertensive and Type 2 Diabetic Patients in a Large Midwestern Health System
Authors: Mary Ingle, Rasha Khatib, Yuxian Du, Vesta Valuckaite, Rakesh Singh, Sheldon Kong, Todd Williamson, Sarang Baman
Journal: Circulation (2022)

Introduction: Clinical practice guidelines recommend regular chronic kidney disease (CKD) screening after a diagnosis of hypertension (HTN) or type 2 diabetes (T2DM). Annual monitoring of kidney function increases early detection of CKD and improves quality of life. However, disparities in neighborhood characteristics can impact access to routine care, including CKD screening. Hypothesis: We hypothesize area deprivation index (ADI), a national ranking of neighborhood sociodemographic disadvantage would predict annual CKD screening and CKD development among newly diagnosed HTN or T2DM patients. Methods: Electronic health records of patients (n=235,208) with an new HTN or T2DM diagnosis between 2015-2018 were abstracted using International Classification Codes. Patients were followed for three years to assess annual CKD screening (one estimated glomerular filtration rate and urinary albumin-to-creatine ratio) and CKD development (CKD or end stage renal disease). ADI ranks (1-100) were divided into quintiles (Q1=least deprived, Q5=most deprived). Multivariable logistic regression models evaluated associations between ADI quintiles with CKD screening and CKD development. Results: Most patients were White (57%) females (55%) with solely HTN (65%). Few with only T2DM (9%) and 26% had both. Screening was highest for patients who developed HTN and T2DM during the study (44%) compared to only T2DM (38%) or HTN (4%). CKD developed for 9% of patients with HTN and T2DM, but 0% for only HTN or T2DM. Compared to the least deprived patients, the most deprived were less likely to not be screened in the first year of HTN or T2DM diagnosis (Odds Ratio (OR)= 0.77; 95% confidence interval (CI): 0.73, 0.80). The most deprived patients were more likely to develop CKD compared to the least deprived patents (OR=1.98, 95%CI: 1.75, 2.23). Conclusions: The most deprived patients were more likely to be screened annually and almost twice as likely to develop CKD compared to the least deprived. Although an increase in deprivation is associated with poor lifestyle choices which can lead to an increase in CKD, it’s possible early diagnosis is due to an increase in screening, thus leading to an increase in quality of life through monitoring kidney function.
Abstract 10655: Collagen Remodeling, Inflammatory Biomarkers and Fatty Acid Regulation in Understanding the Molecular Pathogenesis of Atrial Fibrillation
Authors: Ameer Odeh, Gabriel Dungan, Fakiha Siddiqui, Omer Iqbal, Emily Bontekoe, Debra Hoppensteadt, Lowell Steen, Jawed Fareed, Mushabbar Syed
Journal: Circulation (2022)

Introduction: Atrial Fibrillation (AF) is the most common cardiac arrythmia in the world. Structural remodeling, inflammatory pathways and fatty acid dysregulation are believed to play a role in the development of AF. Hypothesis: This study explored different biomarkers in the blood of AF patients and a control population to determine if there was a significant difference between the two groups. Methods: Sandwich ELISA kits were used to quantify the collagen remodeling proteins, various inflammatory biomarkers and liver type fatty acid binding protein (L-FABP) in the clinically diagnosed AF population (n=78) and the control population (n=50). Non-stratified fatty acids (NEFAs) were measured using an enzymatic colorimetric kit from Wako Diagnostics. Statistical analyses were performed using GraphPad Prism. Results: We found significant upregulation in all the biomarkers in the AF cohort was noted in comparison to the control group. The collagen remodeling biomarkers included MMP-1, MMP-2, TIMP-1, TIMP-2, PICP, PINP, PIIICP, PIIINP and ICTP. All the collagen remodeling biomarkers were significantly higher in AF patients compared to the control group. The inflammatory biomarker TNFa was also elevated in AF compared to the control group. The fatty acid dysregulation biomarkers, L-FABP and NEFAs, were elevated in AF patients as well. Spearman correlation analyses yielded significant correlations between L-FABP and TIMP-1 (r=0.47, p&lt;0.001), NEFA and TIMP-2 (r=0.41, p=0.002), NEFA and ICTP (r=0.41, p=0.002), and NEFA and PIIINP (r=0.61, p&lt;0.0001). Conclusions: The elevation of all the collagen remodeling biomarkers indicates that there is an upregulation of collagen degradation and deposition in AF which could be contributing to atrial fibrosis. The higher TNFa levels indicate that inflammation could also play a role in the pathogenesis of AF. Fatty acid dysregulation biomarkers, including L-FABP and NEFAs, were elevated in AF patients reinforcing the hypothesis that excess fatty acids could also be contributing to atrial fibrosis and epicardial adipose tissue formation.
Abstract 10157: A Rare Case of Triple-Valve Endocarditis Managed Surgically
Authors: Najwan Augustin, Gian Lima
Journal: Circulation (2022)

Introduction: Triple-valve endocarditis is an extremely rare condition associated with poor prognosis and limited guidelines regarding its management. We report the unique case of a patient diagnosed with triple-valve endocarditis who underwent successful surgical intervention of all three valves. Case: A 79-year-old male with a history of benign prostatic hyperplasia requiring chronic indwelling urinary catheter presented with progressive dyspnea, lower extremity edema, and fevers. Physical exam was remarkable for a new holosystolic murmur at his right upper sternal border and jugular vein distention. Chest radiograph was consistent with pulmonary edema and cardiomegaly. A transthoracic echocardiogram revealed a large vegetation on his aortic valve with severe aortic regurgitation, moderate mitral and tricuspid valve regurgitation, and normal ejection fraction. Blood and urine cultures grew Enterococcus faecalis and Enterococcus avium , respectively. A transesophageal echocardiogram showed multiple mobile vegetations attached to his aortic valve, and small vegetations involving his mitral and tricuspid valve (Figure 1). He subsequently underwent surgical aortic valve replacement (23-mm Edwards), mitral valve replacement (27-mm Edwards), and repair of the tricuspid valve septal leaflet after excision of a 3 mm vegetation. He was discharged on ceftriaxone and ampicillin to complete 6 weeks of therapy. During his follow up visit 2 months after surgery, patient was feeling well and engaging in physical therapy. Discussion: There is a limited number triple-valve endocarditis by E. Faecalis in the current literature, and this is the first report of a patient successfully managed with three-valve surgery in this setting. We highlight the importance of early recognition and prompt surgical intervention to achieve favorable outcomes in this population.
Abstract 10739: Impact of Cardiac Device Implantation in Elderly Japanese Patients With Heart Failure as Primary Prevention-A Post Hoc Analysis of the HINODE Trial
Authors: Yoshinari Enomoto, keijiro nakamura, Masao Moroi, Masato Nakamura, Kazutaka Aonuma, Torri Simon, Torsten Kayser, Takanori Ikeda
Journal: Circulation (2022)

Introduction: Despite increase in the incidence of chronic heart failure (HF) and sudden cardia death (SCD), the current use of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) in Japan is much lower than in Western countries. The HF Indication and SCD Prevention Trial Japan (HINODE) was designed to prospectively assess the rate of mortality, appropriately treated ventricular arrhythmias (VA) and heart failure (HF) for comparison with references from historical landmark trial MADIT-RIT in Japanese patients. Hypothesis: This sub analysis of HINODE evaluates the impact of ICD or CRT implantation in elderly Japanese patients concomitant with higher risk of heart failure. Methods: After treatment decisions following contemporary practice in Japan, patients were prospectively enrolled into four cohorts: (1) ICD (2) CRT with defibrillator (CRT-D) (3) standard medical therapy (‘non-device’) (4) pacing (indicated for CRT; received pacemaker or CRT pacing). We compared the all-cause mortality between elderly and non-elderly patients with elderly defined as age&gt;70 at the time of study enrollment. Results: The HINODE study enrolled 354 patients (191 elderly) followed for 19.6 ± 6.5 months with a minimum of 12 months and an absolute death rate of 11.0%. The estimated survival rate for device recipients (n=239) through 24 months was 86.1% (97.5% LCL: 79.8%) with no significant difference for elderly vs non-elderly patients (HR 1.97, 95%CI: 0.86-4.54). Analysis within cohorts showed increased risk of all-cause mortality for elderly with an ICD compared to non-elderly with an ICD (HR 5.09 95% CI: 1.1-23.6). However, ICD cohort excluding those with CRT-D indication showed no significant difference (HR 3.70, 95% CI: 0.75-18.35). No significant difference showed in other cohorts: CRT-D (HR 1.53 95% CI: 0.34-6.84) or pacing (HR 0.84, 95%CI: 0.2-3.5). Ventricular event free rate in ICD and CRT-D patients also had no difference (HR 0.84 95% CI: 0.31-2.25) Conclusions: Although elderly patients might be associated with higher risk of mortality in general, benefit of device therapy is comparable to non-elderly patients. We might consider device therapy despite age as a standalone risk in contemporary Japanese clinical practice.